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[Yuan] Measles and smallpox (痘疮) originate internally from the Zang-Fu organs (Zang-Fu organs) and externally correspond to the Five Movements and Six Qi (Five Movements and Six Qi, i.e., Wu Yun Liu Qi). When the heavens move, the human body follows, without the slightest error. Therefore, for those treating measles and smallpox, it is urgent to understand the Five Movements and Six Qi. Examining past history, outbreaks generally occur every three years. Although sporadic cases may appear in various years, the period of major epidemics is standardized at three years. The so-called "three years" mostly refers to the years of Zi, Wu, Mao, and You. In the years of Zi and Wu, Shaoyin Junhuo (Ministerial Fire of Hand-Shaoyin Heart and Foot-Shaoyin Kidney meridians) governs the Heaven (Si Tian, controlling the first half of the year), while Yangming Zaojin (Dryness Metal of Hand-Yangming Large Intestine and Foot-Yangming Stomach meridians) governs the Earth (Zai Quan, controlling the second half of the year). In the years of Mao and You, Yangming Zaojin governs the Heaven, and Shaoyin Junhuo governs the Earth. Various sores and ulcers are not ignited without Fire, nor collected without Metal. Measles and smallpox take the Shaoyin and Yangming meridians as their primary channels precisely for this reason. However, the profound transformation of Qi shifts subtly; the Principal Qi (Zhu Qi) and Guest Qi (Ke Qi) use each other mutually. The Five Movements differ into Ping Qi (Normal movement), Tai Guo (Excess), and Bu Ji (Deficiency). The Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) differ into Chang Hua (Normal transformation), Yin Sheng (Overacting/Excessive control), Fan Sheng (Counter-control), and Xiang Sheng (Mutual restriction). Even slight differences result in entirely different overall conditions. There are times when measles and smallpox should prevail but do not, and times when they should not prevail but spread everywhere. Thus, one cannot adhere to a single rigid theory.

[Wan] The manifestations of sores and rashes sometimes erupt after an interval of several years, or once erupted, continue year after year. Why? The Classic says: "If one does not know the Qi added to the year, the prosperity and decline of Qi, and the origin of Deficiency and Excess, one cannot be a skilled physician." Generally, Si Tian (governing Heaven) commands the decree of Heaven, occupying the Upper position. Sui Yun (Annual Movement) commands the Qi of generation and transformation of humans and things between Heaven and Earth, occupying the Middle position. Zai Quan (governing Earth) commands the transformation and action on Earth, occupying the Middle-Lower position. Within a year, these Upper, Middle, and Lower Three Qi each execute their transformative decrees. If the Qi occasionally coincides and harmonizes, it penetrates its transformation; if it affects humans, disease occurs. Hence, sores and rashes must wait for the specific year to erupt. Within sixty years, there are twelve Tian Fu (Heavenly符/Agreement) years, where the Annual Movement matches the Si Tian Qi (Wu Zi, Wu Wu, Ji Chou, Ji Wei, Wu Yin, Wu Shen, Yi Mao, Yi You, Bing Chen, Bing Xu, Ding Si, Ding Hai). Among these, four years are Tai Yi Tian Fu (Great Heavenly Agreement), where the Annual Movement, Si Tian, and Earthly Branch attributes all match (Wu Wu, Ji Chou, Ji Wei, Yi You). "Tian Fu" means Si Tian and Sui Yun are identical. "Tai Yi Tian Fu" means Si Tian, Sui Yun, and the Earthly Branch are identical. There are eight Sui Hui (Year Meeting) years, where the Annual Movement matches the Earthly Branch attribute (Bing Zi, Ji Chou, Ding Mao, Jia Chen, Jia Xu, Wu Wu, Ji Wei, Yi You). "Sui Hui" means Sui Yun and the Branch are identical. There are six Tong Tian Fu (Same Heaven Agreement) years, where the Yang-year Sui Yun matches the Zai Quan Qi (Jia Chen, Jia Xu, Geng Zi, Geng Wu, Ren Yin, Ren Shen). There are six Tong Sui Hui (Same Year Meeting) years, where the Yin-year Sui Yun matches the Zai Quan Qi (Gui Mao, Gui You, Gui Si, Gui Hai, Xin Chou, Xin Wei). "Tong" refers to the Sui Yun combining with Zai Quan Qi; Yang years are called Tong Tian Fu, Yin years are called Tong Sui Hui. Speaking of these five categories mixed together, there are thirty-six years; speaking of them combined, there are only twenty-six years. The Classic says: "Tian Fu is called Zhifa (Enforcer), Sui Wei is called Xingling (Order Executor), Tai Yi Tian Fu is called Guiren (Noble Person)." When pathogenic Qi attacks humans, encountering Zhifa results in rapid and critical illness; encountering Xingling results in slow and lingering illness; encountering Guiren results in sudden death. Furthermore, in Zi and Wu years, Shaoyin Junhuo presides; in Yin and Shen years, Shaoyang Xianghuo (Ministerial Fire of Hand-Shaoyang Sanjiao and Foot-Shaoyang Gallbladder meridians) presides. The Classic says: "Where Shaoyin arrives, there are sores and rashes. Where Shaoyang arrives, there are sneezing, vomiting, sores, ulcers, malignant diseases, and sudden death." In these years, if Gang Rou (Yin and Yang) lose their proper positions, and Sheng Jiang (Ascending and Descending) are obstructed, old pathogens do not retreat, and new ones do not migrate, leading to continuous annual outbreaks.

Commentary: The theory of Five Movements and Six Qi occupies nearly half of the *Huangdi Neijing* (Yellow Emperor's Inner Canon), yet few in the world apply it. This is likely because people stick to the constant rules without understanding the variations, thus deeming it ineffective. My friend Miao Zhongchun (Miao Xi Yong) was highly intelligent and skilled in medicine, yet he vehemently rejected the fallacies of Five Movements and Six Qi. I refuted him using the arguments of Wang Yan and Shen Kuo, but he remained unconvinced, probably due to a lack of open-mindedness and detailed inquiry. Suppose Jueyin (Wind-Wood Qi) is in charge; its Qi is predominantly Wind, and the people suffer from Damp-Diarrhea. Does this mean the whole world has much wind and everyone suffers from damp-diarrhea? Even within a single county, rainfall differs. How could such Qi movements be erroneous? It is impossible to claim they are without error. Generally, the principles of things have constants and variables. What the Five Movements and Six Qi dominate are the constants; what abnormal Qi dominates are the variables. Constants resemble the Ben Qi (Principal Qi); variables can reach anywhere and have specific correspondences. Thus, signs vary according to Cong Ni (Following/Opposing), Yin Yu (Excessive Accumulation), Sheng Fu (Overacting/Rebounding), Tai Guo (Excess), and Bu Zu (Deficiency), and their eruptions differ. If Jueyin is in charge, there is much wind and flora flourishes; this is called "Cong" (Following). If the weather is clear and dry without wind, this is called "Ni" (Opposing). If the sky is dusty and murky, and flowing water does not freeze, this is called "Yin" (Excessive). If strong winds break trees and clouds are turbid and chaotic, this is called "Yu" (Stagnation). If mountains and marshes scorch and plants wither, this is called "Sheng" (Overacting). If extreme heat burns and locusts cause disaster, this is called "Fu" (Rebounding). If mountains collapse and earthquakes occur with frequent dust storms, this is called "Tai Guo" (Excess). If it is gloomy and cold at any time, with heavy clouds darkening the day, this is called "Bu Zu" (Deficiency). Diseases and plagues respond to these changes. One must observe the signs of the time and place. Even within a few miles, if the climate differs, the corresponding diseases differ completely. How can one cling to fixed rules? During the Xining era, the capital suffered long droughts despite extensive prayers. For several days, it was overcast, and people believed rain was certain. Then suddenly it cleared, with blazing sun. Shen Kuo and Shi Gong entered court for an audience. The Emperor asked about the rain schedule. Shen replied that the sign for rain had appeared, and it would rain tomorrow. Others argued that despite recent humid overcast days, there was no rain, and how could rain come under such dry conditions? Yet, the next day, heavy rain fell. At that time, Wet Earth Qi was in charge. The previous overcast days showed the effect of the Cong Qi (Following Qi), but it was suppressed by Jueyin Wind Wood, preventing rain. The subsequent sudden clearing indicated Dry Metal Qi entering the season, suppressing Jueyin Wind Wood, allowing Taiyin Wet Earth to expand. The Qi movements became smooth the following day, hence the certainty of rain. Alas! Where can we find someone like Shen Cunzhong (Shen Kuo) today to discuss the Five Movements and Six Qi with?